Tesis

Pengaruh Hidronefrosis Terhadap Respons Tumor dan Tingkat Kesintasan Pasien Kanker Serviks Stadium IIIB yang Menjalani Radioterapi = Impact of Hydronephrosis on Tumor Response and Survival in Stage IIIB Cervical Cancer Treated with Radiotherapy.

Latar Belakang: Hidronefrosis (HN) merupakan komplikasi yang sering ditemukan pada kanker serviks stadium lanjut lokal yang mencerminkan perluasan tumor lokal maupun respons inflamasi sistemik yang berpotensi memicu radioresistensi dan menurunkan angka kesintasan. Temuan ini dikaitkan dengan prognosis yang buruk, namun hubungan prognostik hidronefrosis secara independen pada pasien yang menerima terapi standar masih belum sepenuhnya dipahami, terutama pada stadium IIIB. Tujuan: Menilai pengaruh HN sebelum terapi terhadap respons tumor dan tingkat kesintasan pasien kanker serviks stadium IIIB yang menjalani radioterapi dan brakiterapi. Metode: Penelitian kohort retrospektif dilakukan terhadap pasien kanker serviks stadium IIIB yang menjalani terapi radiasi kuratif di RSUPN Dr. Cipto Mangunkusumo periode 2020–2022. Sebanyak 112 pasien dianalisis, terdiri dari 54 pasien dengan HN dan 58 pasien tanpa HN. Analisis statistik meliputi uji Chisquare, analisis kesintasan Kaplan–Meier, regresi logistik untuk respons tumor, serta regresi Cox multivariat untuk kesintasan keseluruhan. Hasil: Pasien dengan HN memiliki angka respons tidak komplet yang lebih tinggi 35,2% dibandingkan pasien tanpa HN 13,8% (OR = 3,39; p=0,014). Pada analisis multivariat, HN meningkatkan risiko respons tidak komplet secara signifikan (adjusted OR 6,04; IK 95% 1,74–25,5; p=0,009), bersama dengan ukuran tumor ≥5 cm sebagai faktor risiko terkuat kegagalan respons (adjusted OR 7,98; IK 95% 2,28–27,89; p < 0,001). Tingkat kesintasan keseluruhan 3 tahun secara signifikan lebih rendah pada kelompok HN 35,2% dibandingkan tanpa HN 74,1% (p < 0,001). Analisis multivariat menunjukkan bahwa HN (adjusted HR 2,49; IK 95% 1,22– 5,07; p=0,012), status performa ECOG >1 (adjusted HR 2,40; IK 95% 1,27–4,55; p=0,007), dan ukuran tumor ≥5 cm (adjusted HR 1,96; IK 95% 1,08–3,55; p=0,027) merupakan faktor prognostik independen terhadap kesintasan. Median kesintasan pada kelompok HN adalah 24 bulan, sedangkan pada kelompok tanpa HN median tidak tercapai (>36 bulan). Kesimpulan: Hidronefrosis sebelum terapi merupakan faktor prognostik buruk yang independen terhadap respons tumor dan tingkat kesintasan pada kanker serviks stadium IIIB. Temuan ini menegaskan pentingnya evaluasi dini dan penatalaksanaan multidisiplin terhadap hidronefrosis untuk mengoptimalkan hasil terapi dan mempertahankan toleransi terhadap pengobatan.
Kata kunci: hidronefrosis, radioterapi, respons tumor, kesintasan, faktor prognostik


Background: Hydronephrosis (HN) is a frequent complication in locally advanced cervical cancer and reflects both extensive local tumor burden and systemic inflammatory responses that may contribute to treatment resistance and inferior survival. However, the independent prognostic significance of pretreatment HN in patients receiving standard definitive radiotherapy, particularly in stage IIIB disease, remains incompletely defined. Objective: To evaluate the impact of pretreatment hydronephrosis on tumor response and overall survival (OS) in patients with stage IIIB cervical cancer treated with definitive radiotherapy and brachytherapy. Methods: This retrospective cohort study analyzed cervical cancer cases treated between 2020 and 2022 at a national tertiary referral center. A total of 112 patients met the inclusion criteria, comprising 54 patients with hydronephrosis and 58 without hydronephrosis. Tumor response and survival outcomes were assessed using Chi-square tests, Kaplan–Meier survival analysis, logistic regression to estimate odds ratios (OR), and Cox proportional hazards regression to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: Patients with HN exhibited a significantly higher rate of noncomplete tumor response 35.2% compared with those without HN 13.8% (OR = 3.39; p = 0.014). On multivariable analysis, HN was independently associated with an increased risk of noncomplete response (adjusted OR = 6.04; 95% CI 1.74–25.5; p = 0.009), along with tumor size ≥5 cm, which emerged as the strongest predictor of treatment failure (adjusted OR = 7.98; 95% CI 2.28–27.89; p < 0.001). Threeyear overall survival was significantly lower in patients with HN 35.2% compared with those without hydronephrosis 74.1% (p < 0.001). Multivariable Cox regression identified HN (adjusted HR = 2.49; 95% CI 1.22–5.07; p = 0.012), ECOG performance status >1 (adjusted HR = 2.40; 95% CI 1.27–4.55; p = 0.007), and tumor size ≥5 cm (adjusted HR = 1.96; 95% CI 1.08–3.55; p = 0.027) as independent adverse prognostic factors for overall survival. The median overall survival was 24 months in the HN group, whereas it was not reached (>36 months) in patients without HN. Conclusion: Pretreatment hydronephrosis is an independent adverse prognostic factor for tumor response and overall survival in patients with stage IIIB cervical cancer receiving standard definitive therapy. Early identification and multidisciplinary management of hydronephrosis are essential to improve therapeutic outcomes and maintain treatment tolerance.
Keywords: Hydronephrosis, radiotherapy, tumor response, overall survival, prognostic factor